What is surgery?

[brightlywoven]

A question, prompted by my encounter yesterday with a mad person. What is surgery to you? Is it:

a) Something that is inherently risky and painful, to be resorted to only when the likely benefits outweigh the likely harms (and almost certain pain).

b) An assault on the body's integrity and a form of charlatanism. I'll have some Noni juice and a Reiki massage, please.

c) A way to get some TLC and attention from nurses/surgeons/my family (plus, cool scars!).

d) The only way to fix a problem for good.

e) My NHS given right dammit, and I'm not leaving till I get some!

f) A totally valid career choice.

Discuss (If f, it's OK, you may go now. Here's a fresh pair of scrubs and a banana for you.)

Comments

[wellinghall.livejournal.com]

Speaking as someone whose experience of major emergency surgery was all too recent, I'd have to say a) and d).

[dr-biscuit.livejournal.com]

I'll grant you a), but d)? Really really? If you have a sore throat, do you think the best way to properly fix it (given limitless resources) is a tonsillectomy?

(I'm not meaning to sound disingenuous. I think I have found a disconnect between my thinking and that of many laypeople. )

[wellinghall.livejournal.com]

Oh, no! what I think I meant was:

d1) in some cases, the only way to fix it.

This is totally distinct from:

d2) always / necessarily the only way to fix it.

What did your mad person think?

[dr-biscuit.livejournal.com]

Combination d/e I think (though I suspect a little of c in the mix as well). Wanted an operation 'to fix the pain', is surprised when, after said operation there is post-operative pain! (Will probably be further surprise when she realises her original pain is not fixed by said op).

On the other hand, it's never a good prognostic factor to find a person reading their chart, and the first words out of their mouth are 'it says here they're supposed to be giving me morphine in the drip every 4 hours, and they're not!' (Smart enough to work out all that, but not smart enough to see that the order is under a big heading 'to be given if required'

[rustica.livejournal.com]

Well, there's surgery and there's surgery, isn't there? Surgery can diagnose a problem, or it can fix a problem. It can be totally elective (eg, cosmetic), highly advisable or it can be emergency. Or any combination of the above and probably lots more.

My surgery (today, as it happens!) was not something I was looking forward to, but it was a solution to a problem, in the same way as my root canal surgery will be later this year. My dentist initially tried to persuade me that I didn't want to have the nerve removed, but it's stupid and annoying to keep being in pain with it when it's pretty easy to fix this way and we've tried everything else. I wouldn't let a/ discourage me from that - yes there will be pain but there will also be anaesthetic!

I'd go with a/ and d/, with my qualifier for d/ being that surgery is the either the last resort after the other options have been tried or that it is the most efficient solution.

[dr-biscuit.livejournal.com]

>Well, there's surgery and there's surgery, isn't there? Surgery can diagnose a problem, or it can fix a problem

Oh god, you have no idea how hard it is to convey this to some people! It seems self evident to me, but it seems some people here 'operation' and think 'they're going to fix me'. There are definitely cases where to operate is the most sensible option. There are others where to operate causes more problems than it's like to fix. The concept of risk/benefit analysis is very difficult to convey to a subset of people.

(I have sat in a gynae clinic as a student and seen patients come in with years of pelvic pain. After being observed for long enough, most of them got a total hysterectomy plus tubes/ovaries removed. When their pain continued the gynaecological surgeons would happily say 'well I know it's not your reproductive tract, because I've taken all that out. So I'll be referring you to the gastrointestinal surgeons now.' This is the result of the 'surgery will fix pain' mindset!)

I'm beginning to wonder if this is because the health system holds 'the keys' to the surgery cupboard, which creates a heightened air of desirability. ("If the queue's this long, it's gotta be good!"). While I don't think a/ is meant to be a discourager, I think that an acknowledgement of this fact would result in much more realistic expectations).

[rustica.livejournal.com]

"This is the result of the 'surgery will fix pain' mindset!"

I can understand a patient with severe and chronic pain having this hope/mentality, and also to a lesser extent the doctors who treat them. It's simple desperation. And if a docter were to say, look, you'll be in this much pain for the rest of your life - apart from the horror for the doctor of having to say this, they would probably then also have to explain themselves to the coroner shortly afterwards... And who's to say that the next surgery won't help?!

But there's a great difference, I think, between a small number of people who really do have something serious wrong with them, and a larger number of people who *think* they have something serious wrong with them.